Scurvy and the Brave Second Year Resident

Adult Scurvy

Hirschmann JV and Raugi GJ. J Am Acad Dermatol 1999;41(6): 895-906

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"In 1939, John Crandon, a second-year surgical resident at Boston City Hospital, decided to investigate the effect of vitamin C deficiency on wound healing.[1] [4] Believing that such a study should involve at least 3 subjects, he enticed 2 teenagers to join him as paid volunteers in a diet devoid of vitamin C. The experiment soon had only one participant, for after 3 weeks the two youths were spotted drinking orange juice in a restaurant.

Crandon persevered, eating only in the hospital cafeteria and a nearby delicatessen and subsisting solely on a regimen of cheese, bread, crackers, eggs, beer, coffee, and chocolate, supplemented by riboflavin, niacin, yeast tablets, and wheat-germ oil. For the first 2 months he also had well-cooked meat and a small amount of cream. This experiment had ominous precedents, for in 1770, William Stark, a 29-year-old British physician, died while conducting similar dietary studies, and many accounts of scurvy described sudden, unexpected deaths.[4]

Using a newly available test to measure levels of vitamin C, Crandon found that it was absent in his plasma at 41 days and in his white cells at 82 days. To test wound healing at that point, on day 90 he underwent a 6-cm transverse incision on his back, with removal of a small sample of muscle. To his disappointment, a biopsy 10 days later revealed normal wound healing. Nevertheless, he remained on his diet. After 3 to 4 months fatigue developed, which worsened as his experiment continued, and he began to let his work slip. He performed surgery all day and was on call every other night. He started taking afternoon naps and became reluctant to see patients in the evenings.

At day 134, as he scratched his buttocks and calves, he noticed that his skin felt like sandpaper because hyperkeratotic papules had appeared. At day 155 for the fourth time since beginning his dietary regimen, he donated a pint of blood for money to defray the cost of eating at the delicatessen. His systolic blood pressure dropped from 120 to 90 and never again exceeded 100 during the experiment.

At day 162 perifollicular hemorrhages developed over his lower legs, which seemed to increase with protracted standing and subsequently extended to his lower thighs. At day 180 while performing an exercise test, his heart rate reached 190, and, experiencing a sense of imminent death, he collapsed, momentarily losing consciousness. At about the same time a wound from an appendectomy 15 years before began to disintegrate. At day 182 he underwent a repeat incision on his back; the sutures through the fascia held poorly. A biopsy of the site 10 days later showed no healing beneath the skin, where unorganized blood clot filled the wound, necessitating a drain.

At that point, while remaining on his diet, he began receiving daily intravenous vitamin C. A repeat biopsy 10 days later showed normal healing. His experiment thus proved that vitamin C deficiency impairs wound healing and repletion of the vitamin corrects the problem."

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Last update: 7/7/02; 11:49:36 AM.